Economic Aspects of Endovascular Treatment of Pelvic Venous Disorders

Objective. To evaluate the economic costs of treating patients with a combination of left common iliac vein compression stenosis (LCIVCS) and pelvic venous insufficiency (PVI) using various endovascular techniques considering their clinical effectiveness. Material and methods. This retrospective cohort comparative study included 55 patients with hemodynamically significant LCIVCS and PVI. Primary stenting of the left common iliac vein (LCIV) was performed in 49 patients (Group 1), and primary left-sided ovarian vein embolization (OVE) was used in 6 patients (Group 2). The clinical outcome of primary stenting of the LCIV and OVE was assessed by recording the dynamics of chronic pelvic pain (CPP) using visual analogue scale (VAS) 10 days, 1, 3 and 6 months after the interventions. The financial costs of stenting of the LCIV, OVE and combined use of these two treatment methods were assessed individually. Results. After stenting of the LCIV, a significant reduction or complete resolution of chronic pelvic pain (before treatment: 8 [7—9] points; after 6 months: 1 [0—2] point; p=0.005) was noted in 69.4% of patients. The clinical effect of stenting was insignificant in 30.6% of patients and they underwent OVE. After primary OVE, no positive clinical effect was observed in 100% of cases, CPP persisted (before treatment: 7 [5—9] points; after 6 months: 7 [6—9] points; p=0.73). These patients underwent stenting of the LCIV, which was accompanied by a significant reduction in CPP. The personalized cost of treatment in the 1st group was 220 666.97 rubles, in the second — 316 517.46 rubles; when using primary stenting of the LCIV, the cost savings for the treatment of one patient amounted to 43.6%. Conclusions. Primary stenting of the LCIV in patients with a combination of the LCIVCS and PVI is the optimal treatment strategy in terms of clinical effectiveness and economic feasibility. The clinical effectiveness of isolated LCIV stenting is 69.4%, and financial savings — 43.6%.